Taming the SRU

SEPTEMBER 15, 2023

ETT onto a fiberoptic scope.

CPR 90

CPR Burns Airway Management Wellness 90

The Skeptics' Guide to EM

MAY 8, 2021

He is an EMS medical director with Lexington Fire/EMS as well as the AMR/NASCAR […] The post SGEM#329: Will Corticosteroids Help if…I Will Survive a Cardiac Arrest? He is an EMS medical director with Lexington Fire/EMS as well as the AMR/NASCAR Safety Team. first appeared on The Skeptics Guide to Emergency Medicine.

CPR 52

CPR Hyperthermia / Hypothermia EMS Documentation/Coding 52

The Skeptics' Guide to EM

OCTOBER 28, 2017

Case: A 12-day old girl presents with fever and is otherwise well. That rant relied upon a Cochrane SRMA by Stevens B et al 2013 and a randomized clinical trail published in Pediatrics by Gray L et al 2015. Anthony is also the creator of SketchyEBM. You wonder whether there is a way to mitigate the painful experience for the child.

Pediatrics 52

Pediatrics Documentation/Coding Emergency Department Hospitals 52

The Injectable Orange

JUNE 20, 2017

While well evaluated, you see the residents go back to the shop floor and struggle to apply any of the lessons that the group agreed had been take homes from the previous sim session. How do they do it so well?” doi: 10.1136/bmjopen-2013-003525 Lorello, G, Hicks, C et al. 2013 Dec;26(6):699-706. Well done”…….

Head Injuries 52

Head Injuries Documentation/Coding Wellness Resuscitation 52

Taming the SRU

FEBRUARY 5, 2024

(1) However, it wasn’t until the 1890s that purposeful, successful, and safe attempts to access this fluid were documented (2). The LP is now a standard procedure and in 2010 well over 135,000 LPs were performed in Emergency Departments throughout the US (3). (And Clin Infect Dis. 2018;66(3):321-328. doi:10.1093/cid/cix806 5.

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

SheMD

OCTOBER 8, 2023

In 2013, a large survey with 7,028 respondents found that 64.8% Actually, I wanted to ask what supports the program has in place for parents (male and female) as well as people increasing their families, be it biologically or through adoption?” Their well-being should be considered. Thank you for this question !

Leadership 105

Leadership Best Practices Academics Documentation/Coding 105

Pediatric Emergency Playbook

APRIL 1, 2016

Brain natriuretic peptide (BNP) In adults, we typically think of a BNP Luckily, we have data in children with congenital heart disease as well. This has been studied in children as well, and an elevated lactate in children – typically above 4 – was a predictor of prolonged ICU course and mortality in septic patients. 2013; 29:715-719.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

RebelEM

AUGUST 12, 2024

Thus further adding to the well known safety of amino acid infusions The lack of a diversified patient population in combination with having used only one type of amino acid formulary greatly limits this study’s generalizability. Contemp Clin Trials. Epub 2022 Aug 28. PMID: 36038001 Levi TM, et al. Rev Bras Ter Intensiva.

Outcomes 81

Outcomes Hospitals Operations Shock 81

Pediatric Emergency Playbook

JUNE 1, 2017

This child is at risk for expected complications, as well as overdiagnosis and iatrogenia. These children depend on their preload to run blood passively into the pulmonary circuit; afterload reduction is also important to compensate for a poor left ejection fraction, as well as to avoid the development of pulmonary hypertension.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Advanced Emergency Nursing from AENJ

NOVEMBER 20, 2014

It is critically important to document the physical findings in a plain-seeing, plain-speaking, non-judgmental manner that will not color or taint future investigations. Accurate time entries are important to document. If you think your patient is the perpetrator, he may well be an innocent, or even an off-duty or undercover officer.

Military 40

Military Forensics Documentation/Coding Emergency Nursing 40

Dr. Smith's ECG Blog

JULY 22, 2023

The patient did well and was ultimately discharged home. Our patient had a Brugada Type 1 pattern elicited by an elevated core temperature, which is also a documented phenomenon. As for our patient, on discharge, her EKG had completed returned to her baseline morphology and she has been doing well in follow-up.

EKG/ECG 92

EKG/ECG Hyperthermia / Hypothermia Documentation/Coding Wellness 92

Northwestern EM Blog

SEPTEMBER 12, 2022

It is well known that most hospitals in large population centers already operate at or near full capacity [4]. Other things listed on tags can be a patient’s name, bar code, MRN or other tracking criteria. This makes it even more challenging when presented with an acute influx of patients in a short period of time. EPM , 5 Apr.

Mass Casualty Incidents 52

Mass Casualty Incidents EMS Hospitals Hazardous Materials 52

ACEP Now

AUGUST 1, 2023

Recent data published in Annals showed that between 2013 and 2019, the percentage of clinicians working in rural areas who were emergency physicians actually dropped slightly. A rural ED staffed by a well-trained EP is an essential resource in small communities that may be otherwise lacking in readily available healthcare resources.

Emergency Department 98

Emergency Department EMS Critical Access Hospitals 98

Don't Forget the Bubbles

MARCH 11, 2024

There are many causes, and it is less well understood than plagiocephaly. Recommendations for sudden infant death syndrome prevention: a discussion document. Craniosynostosis Craniosynostosis is rare. It is due to the premature closure of the sutures rather than positional changes to an otherwise normal skull. Vollman, A. Hatfield, J.,

Radiology 59

Radiology Radiology Pediatrics Documentation/Coding 59

PulmCCM

FEBRUARY 19, 2024

Well … no. At Shands (the level 1 trauma center admitting adults), the panel relates the impressive results that mortality fell by 58%, and unplanned codes by 47% “after the widespread implementation of patient/ family activated RRT/MET.” Family-Activated METs in Adults Halves Mortality?

Hospitals 52

Hospitals Resuscitation Burns Documentation/Coding 52

ACEP Now

DECEMBER 10, 2023

Although cases of human milkweed exposure are rare, a 2013 case reported a 42-year-old man experiencing cardiac symptoms and nausea after consuming fried milkweed pods from a recipe he found online. In the ED, he was found to have a heart rate in the 40s, and a digoxin level of 1.0 ng/mL (cross reactivity of the assay) and a potassium of 4.2

Poisoning 52

Poisoning Seizures Documentation/Coding Emergency Department 52

Pediatric Education

MARCH 10, 2024

She was doing well and but was having problems with her math and some reading. “She’s doing well socially and developing pretty normally, so that is good. They learn or do some things exceptionally well, but they also are exceptional in that they have problems learning too. Assouline, Nicholas Colangelo, 2013.

Leadership 40

Leadership Wellness Pediatrics Documentation/Coding 40

Dr. Smith's ECG Blog

JUNE 30, 2023

Smith and Meyers containing thousands of tracings with documentation of cardiac catheterization results. Criterion #5: Chest leads with T-wave inversion often have some ST elevation ( This is especially well seen in leads V3,V4,V5 of ECG #1 ).

EKG/ECG 52

EKG/ECG Documentation/Coding Outcomes Wellness 52

Advanced Emergency Nursing from AENJ

JULY 9, 2015

Pull out the manikins (or use a volunteer; BVM only) and run some awkward codes! Flexibility of mind and skill bodes well. Wiget, Urs & Torres, Eric. Video] Sep 15, 2013. Video] Nov 19, 2013. How versatile are your airway skills? Oh, sure, you can handle any supine situations! Gather everyone. Before} 19 May 01.

Airway Management 40

Airway Management Pediatrics Resuscitation Emergency Nursing 40

Dr. Smith's ECG Blog

JANUARY 30, 2019

I remember Allie well from her days in the Research volunteer program at Hennepin. Smith comment: 1) Brugada ECG may have ST shifts in limb leads as well as precordial leads. A repeat EKG was performed at that time and showed this: The STE had almost completed resolved and the STE depression is improved as well. F (rectal).

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG Wellness Documentation/Coding 52

Dr. Smith's ECG Blog

MAY 8, 2023

Code STEMI was activated by the ED physician based on the diagnostic ECG for LAD OMI in ventricular paced rhythm. There is concordant ST elevation in I, aVL with reciprocal concordant STD in inferior leads, as well as excessively discordant TE in V2-V4. This is a huge anterolateral OMI. I cannot be anything else.

EKG/ECG 52

EKG/ECG Documentation/Coding Outcomes Shock 52

Advanced Emergency Nursing from AENJ

MAY 3, 2014

Although told several times, the story of the development by Henning Ruben of the prototypical modern manual resuscitator, the self-refilling bag with unidirectional non-rebreathing valves which now dominate the world of resuscitation, is still not well-known. Documents improvements in BVMs previously investigated and found deficient in FIO2.

Resuscitation 40

Resuscitation Military Operations Emergency Nursing 40

EB Medicine

JULY 8, 2019

Jeff: Well that’s kind worrisome. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in. Jeff: Do note, however that 2013 guidelines do not recommend one procedure over another and leave that decision up to local surgical expertise, patient specific risk factors, and treatment goals.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Clinical Course The paramedic activated a “Code STEMI” alert and transported the patient nearly 50 miles to the closest tertiary medical center. 2 The astute paramedic recognized this possibility and announced a CODE STEMI. N Engl J Med 2003; 348:1756-1763, 5/1/2013. Look at the aortic outflow tract. What do you see?

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

Northwestern EM Blog

MAY 16, 2022

The above study was well summarized and bears repeating that, in this multicenter randomized study assessing CT vs POCUS vs radiology performed US in patients with suspected renal colic in the ED setting, initial US reduced radiation exposure without adversely affecting patient-centered outcomes. References Fwu, C. Eggers, P. Kimmel, P.

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

This patient was reported to have distant heart sounds but was not hypotensive and did not have JVD according to documentation. 2013 Sep;26(9):965-1012.e15. There appears to be some ST elevation in leads II and aVF, as well as to a lesser extent in the lateral chest leads. J Am Soc Echocardiogr. doi: 10.1016/j.echo.2013.06.023.

EKG/ECG 40

EKG/ECG Ultrasounds Documentation/Coding COPD 40

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

A natural one, and especially suited for increasing capability without regard to physician residency program output of graduates, and in less-well-served rural areas. 10/20/2013. EMS in America: The Foundation Documents. 1950s & 1960s Resuscitation Research. There is also FOANed for Nursing. How the BVM began.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

EB Medicine

AUGUST 6, 2019

Nachi: Well, I’m sure more of those studies are still coming. Nachi: Well that was a ton of information and background on the DOACs. Interestingly, one retrospective study found limited agreement between EMS records and hospital documentation on current DOAC usage. Show More v Jeff: Fair enough, we’ll take what we can get.

Emergency Department 40

Emergency Department Stroke Wellness Resuscitation 40

EB Medicine

MAY 3, 2019

The PSS-3 assesses for depression/hopelessness and suicidal ideations in the past 2 weeks as well as lifetime history of suicide attempt. Next, schedule a follow up appointment, ideally within a week of discharge, and lastly, document the patient’s preferred follow up resources and steps taken to get them there. Reference book) 15.

Emergency Department 40

Emergency Department Psychiatric Documentation/Coding Outcomes 40

EMDocs

FEBRUARY 12, 2024

ABG and VBG Correlation The correlation between venous and arterial blood gases is well-documented for standard differences (Table 1), and the data obtained from the VBG can be acted on as if it were an ABG (1, 3-6). While ABGs and VBGs usually correlate well, there are a few situations where this correlation is disturbed.

Emergency Department 98

Emergency Department Resuscitation COPD Shock 98

RebelEM

MAY 15, 2024

The loss of these cells leads to immunosuppression as well as decreased responsiveness of the immune system as a whole Patients with neutropenia will not only get very sick very quickly, but also will have blunted immune response and may not localize signs of infection well Fever or malaise may be their only presenting symptoms.

Infectious Diseases 101

Infectious Diseases Administration Sepsis Anaphylaxis 101

ACEP Now

OCTOBER 9, 2023

percent) do not speak English as a primary language, and 25 million of those speak English less than well (known as “limited English proficiency” or LEP); many indicators show this number will only continue to grow. Physicians should document the interpreter’s name and identification number if available in the patient’s chart.

Emergency Department 64

Emergency Department Documentation/Coding EMS Wellness 64

Ziqitza HealthCare Ltd

JULY 14, 2023

Of these, about 7 lahks, or 30 per cent, were reported under Section 498A of the Indian Penal Code (IPC), the report says. These dedicated numbers are operational 24X7, are toll-free and available to women promptly, and have integrated call centres that operate round-the-clock for providing legal or police aid as well as medical services.

Domestic Violence 52

Domestic Violence Documentation/Coding Operations Ambulance Services 52

Pediatric EM Morsels

FEBRUARY 2, 2024

In one ED study, ALL cases of missed travel-related illness did not have a documented travel history in their ED note , whereas 90% of the identified travel-related illnesses had a provider documented travel history (Greenky 2022) Those who are visiting friends and relatives (VFR) are typically at highest risk.

Infectious Diseases 164

Infectious Diseases Pediatrics Sepsis Documentation/Coding 164

EB Medicine

JANUARY 2, 2019

This corresponds nicely to a 2013 retrospective study demonstrating a bHCG threshold for the fetal pole to be just below 1400. For a completed abortion, you would expect a closed OS with no IUP on ultrasound with a previously documented IUP. Generally 1500 is used as the cutoff. Jeff: Let’s move on to disposition.

Ultrasounds 40

Ultrasounds Radiology Radiology Infectious Diseases 40

Sensible Medicine

AUGUST 14, 2024

In popular (lay) understanding, SIDS represents a common danger that a well-cared for and apparently healthy baby will suddenly and terrifyingly be found dead in the morning. ” Indeed, cause of death is coded differently over time and across counties, states, and countries. from 57% in 1993 to 82.5%

CDC 94

CDC Sepsis Research Pediatrics 94

RebelEM

DECEMBER 23, 2024

saline (NS) solutions are both isotonic crystalloids widely used for intravenous fluid resuscitation across many contexts and disease states ( Myburgh 2013 ). Lactated Ringer (LR) and 0.9% This introduces the risk that data may be less accurate than with prospective enrollment, access to medication administration records, etc.

Fluid Resuscitation 129

Fluid Resuscitation Resuscitation Documentation/Coding Outcomes 129